Bernstein A D, Parsonnet V
Division of Surgical Research and the New Jersey Pacemaker and Defibrillator Center, Newark Beth Israel Medical Center, Newark, New Jersey, USA.
Am J Cardiol. 1996 Jul 15;78(2):187-96.
A survey of implanters of permanent cardiac pacemakers and implanted cardioverter-defibrillators (ICDs) in the United States during 1993 was conducted to identify present and changing patterns in indications for pacing implantation techniques, pacing-mode selection, follow-up, and opinions regarding pacing-and ICD-related issues. Five major pacemaker manufacturers also provided estimates of the numbers of pacemakers and ICDs implanted in the United States from 1990 through 1993. In 1993 approximately 133,000 new rhythm-management devices, including 112,000 primary pacing systems and 16,000 ICDs, were implanted, an increase of 18% for pacemakers and 113% for ICDs since 1990. In 1993, pacemaker implantations were performed by about 8,700 physicians working in 3,300 hospitals and 1,000 independent "surgi-centers." Since the last survey, which addressed pacing practices in 1989, respondents' use of dual-chamber pacemakers increased from 32% to 68% of the total, and adaptive-rate systems from 29% to 48%. Significant differences (p <0.05) were found among subcategories of implanters and among complications encountered in different circumstances. Surgeons tended be the older and more experienced implanters, but used a smaller proportion of active-fixation leads, dual-chamber systems, and adaptive-rate pulse generators, and tended to rely more heavily on a pacemaker manufacturer's representative in operative and follow-up procedures. Complications were more common with bipolar leads, with leads implanted by means of an introducer, and with passive-fixation ventricular leads. The survey provided useful insights into trends and differences in pacemaker and defibrillator practice. Future surveys would be facilitated if a standardized implant registry such as that used in Europe were established in the United States.
1993年，对美国永久性心脏起搏器和植入式心脏复律除颤器（ICD）植入者进行了一项调查，以确定起搏植入技术、起搏模式选择、随访以及关于起搏和ICD相关问题的意见的当前和变化模式。五家主要的起搏器制造商还提供了1990年至1993年在美国植入的起搏器和ICD数量的估计值。1993年，大约植入了133,000个新的心律管理设备，包括112,000个初级起搏系统和16,000个ICD，自1990年以来，起搏器增加了18%，ICD增加了113%。1993年，约8700名医生在3300家医院和1000家独立的“手术中心”进行了起搏器植入手术。自上次于1989年进行的关于起搏实践的调查以来，受访者使用双腔起搏器的比例从总数的32%增加到了68%，自适应速率系统从29%增加到了48%。在植入者的子类别之间以及在不同情况下遇到的并发症之间发现了显著差异（p<0.05）。外科医生往往是年龄较大、经验更丰富的植入者，但使用主动固定导线、双腔系统和自适应速率脉冲发生器的比例较小，并且在手术和随访程序中往往更依赖起搏器制造商的代表。双极导线、通过导引器植入的导线以及被动固定心室导线的并发症更为常见。该调查为起搏器和除颤器实践的趋势和差异提供了有用的见解。如果在美国建立一个像欧洲使用的标准化植入登记系统，将有助于未来的调查。
